Polycystic ovarian syndrome (PCOS) is a clinical diagnosis characterized by oligo-ovulation, hyperandrogenism, and often the presence of polycystic ovaries. A common disorder, PCOS affects about 10% of reproductive-age women.Women often present with amenorrhea or oligomenorrhea, hirsutism with acne and male-pattern hair growth, weight gain, and difficulty with fertility. PCOS is associated with an increased risk of developing diabetes mellitus and cardiovascular disease.
Diagnostic criteria for PCOS vary by organization, although all include a component of ovarian disease and the exclusion of alternative diagnoses (refer to Table 1.). Differential diagnosis includes thyroid disease, hyperprolactinemia, androgen-secreting tumors, adrenal hyperplasia, and Cushings syndrome. Depending on a womans presenting symptoms, consider laboratory testing that includes a pregnancy test, TSH (thyroid stimulating hormone), prolactin, total and free testosterone levels, dehydroepiandrosterone (DHEA) sulfate, morning 17a-hydroxyprogesterone, and 24-hour urine cortisol level. Transvaginal ultrasound may show characteristic changes associated with PCOS, but is not required for the diagnosis if the hormonal features of PCOS are present.
Table 1. Differing Criteria for Polycystic Ovarian Syndrome Among Organizations
|Organization||Criteria||Ovarian Dysfunction||Ovarian Morphology||Hyper-androgenism|
|National Institutes of Health (1990) ||Both of the following and exclusion of related disorders||Oligo-ovulation (less than six menses per year)||Not applicable||Clinical or biochemical (not specified)|
|Rotterdam Group (2003) ||Any two of three of the following and exclusion of related disorders||Oligo-anovulation (nonspecified)||Polycystic ovaries (>12 follicles 2 to 9 mm, or ovarian volume >10 mL)||Clinical or biochemical (free testosterone or free testosterone index)|
|Androgen Excess Society (2006) ||Hyperandrogenism as critical, with addition of at least one ovarian marker and exclusion of related disorders||Oligo-anovulation and/or polycystic ovaries||Oligo-anovulation and/or polycystic ovaries||Clinical or biochemical (free testosterone)|